island county community health improvement plan ...wgh hospital administration primary care...

____________________________________________________________________________________________ Prepared by Laura Luginbill, Assessment and Healthy Communities Director of 24 Last Updated: April 22, 2016

ISLAND COUNTY PUBLIC HEALTH

Assessment & Healthy Communities

Island County Community Health Improvement Plan Prioritization Workshop #2 Summary and Discussion Wednesday, April 13, 2016

Introduction In 2015, Island County Public Health initiated a community health planning process to assess the health of Island County residents, and identify solutions for addressing the most pressing needs. After completing a ‘Community Health Assessment’ (CHA) in November 2015, Public Health staff and the Island County Community Health Advisory Board (CHAB) staged a series of steps to analyze and prioritize issues assessed within the CHA. The second phase of community health planning – development of the Community Health Improvement Plan (CHIP) -- will describe how public health and the community will work together to improve the health of the population. It is a tool that brings together multiple sectors to address a problem that is too big to address alone, and is a form of accountability written and implemented by the community. The process of creating a CHIP sets health-related priorities, identifies programs and policies for implementation, and directs the use of resources. An initial workshop was held in February 2016, in which data was presented to a broad gathering of 56 community leaders and experts regarding 8 health-related topics. The purpose of this workshop was to interpret and evaluate the presented data, and begin to narrow prioritization areas for the CHIP. Results from that workshop included the following:

‘Access to Health Care’ and ‘Housing’ are clear areas of need and are priorities in the community

Mental Health, Violence, and Substance Abuse all have significant points of concern, and the priority focus is where 2 or more of those issues interconnect

Root cause analysis and the mapping of relationships between issues are important next steps for better understanding each priority topic

Workgroups dedicated to each prioritized topic should be formed, and each group tasked with creating the Community Health Improvement Action Plans.

This second workshop was created to further narrow priorities, and to implement recommendations received from Workshop #1. Specifically, the goals of Workshop #2 were:

Analyze existing data in four priority areas: Access to Care, Housing, Depression and Suicide, and Interpersonal Abuse

Identify areas of strength and concern within those priority areas

Determine single priority issues within those areas

Conduct a root-cause analysis on each of those priority issues

Propose next steps/action strategies to address the primary root causes for each priority issue.

Island County Community Health Improvement Plan Prioritization Workshop #2 Summary


Methods Participation All participants from Workshop #1 were invited to participate in Workshop #2. CHAB members and Workshop #1 participants were asked to recommend other experts and leaders for the four workshop topic areas. Participation was limited to 8 participants per topic area to facilitate discussion and workgroup cohesion. Participants were assigned workgroups according to their representative population and area of expertise. Workshop facilitation was led by Bess Windecker Nelson, PhD, LMFT of Family Touchstone, LLC. Data Data were presented on posters organized by topic. Data included public health indicators, and results from the 2015 Island County Community Health Survey, 2015 Island County Community Focus Groups Report, Opportunity Council Prosperity Project Report, United Way ALICE Project, Island County 2015 Homeless Point in Time Count, and the 2016 Island County Homeless Youth Survey. Copies of the posters are available in Appendix A. Workshop Tasks The workshop was structured into six tasks, described below. See Appendix B for the official workshop agenda.

Data Carousel Workgroups rotate through data presented for the following topics: Access to Care; Housing; Depression and Suicide; and Interpersonal Abuse. Participants write observations on sticky notes, identifying strengths, concerns, and missing data.

Theme/Cluster Observations and Selection of 1 Primary Issue At their home station, participants cluster/theme observations from the data carousel, and determine one primary strength and one primary concern.

Root Cause Analysis At their home station, participants brainstorm the “Whys” for primary concern to determine root causes.

Significance/Control Evaluation At their home station, participants evaluate each root cause on the community’s level of control, and the significance of the issue

Mapping At their home station, participants take all root causes determined to be of “high significance/high control”, and map their relationships to each other. This determines what factor(s) have the greatest impact on other root causes, and where actions could have the greatest impact. Identifying Concrete Steps to Address the Primary Root Cause At their home station, participants brainstorm what steps can be taken to begin to address the root causes, and which additional people should be recruited to participate in the workgroup dedicated to that issue.

Two opportunities were provided for workgroups to report out to the larger group on their progress and results. Results from each step for each workgroup were documented.



Results Participation A total of 39 community representatives participated in Workshop #2, representing 23 organizations. A full list of participants is available in Appendix C. Topic Area Results Results from each step of the workshop were recorded for each topic, and documented below.

.

Step 1: Data Carousel Results: Strengths and Concerns

Strengths *

73% have visited dentist – higher than US average

Island County has a higher percentage of dentist visits than Washington State and the United States

Dental very better than US average

70% of respondents said healthcare is important to them

70% reported having a personal physician

About 60% of adults said they had a medical checkup in the past year

Most (91%) said they had health insurance.

Medicaid is filling needs of poor people

Whidbey and Camano draws higher income for retirement. Greater income equals greater access.

Access on par with state and national data

Concerns

Whidbey Island residents are not educated optimally about what health care resources are available.

Higher rate of people getting regular medical care through the ER. It is 2x higher than Whatcom County and 3x higher than San Juan County.

36% of respondents said dental care was very hard to get.

30% usual care through ER

40% did not have a medical checkup last year

Many people did NOT have a primary care provider (they use specialty care)

44% didn’t get care because of cost

Only 42% of families with children report receiving adequate medical care

Fewer medical checkups

60% medical/dental debt

Cost is a barrier for medical and dental

58% of children don’t get adequate medical care

Island County residents are less likely to have a personal physician

I. Access to Care



Low income residents (30%) said access to medical care was a common daily challenge

#2 most common daily challenge for low income

70% of respondents with income below 100% poverty level are on Medicaid or not insured.

9% with NO coverage

There are ~40 free clinics in WA. Whidbey has NONE.

Increased services needing for aging population.

Other

I do not see information on 0-18 year olds for visits/access. (22% of our population)

Need to know number of Medicaid Providers in Island County

Cost is not the main reason adults didn’t see a doctor. What are the other reasons?

Island County coordinating with other health organizations outside Whidbey as well – Camano – Skagit or Providence

Navy Hospital services reduced impacts WGH and Island Hospital.

* Other participant groups were encouraged to check the strengths, concerns, and missing data that had been identified by prior groups, rather than create duplicate comments.

Step 2: Theme/Cluster Observations and Selection of 1 Primary Issue

Primary Issue: Appropriate knowledge/awareness usage availability of primary care vs ER Steps 3 and 4: Root Causes and Control/Significance Analysis

Low Control and Low Significance

Hospital needs to be more involved with outpatient care

Navy has no co-pay so they have to ER for minor things

High Control and Low Significance

Transportation

Transportation to appointments

Low Control and High Significance

Apathy and procrastination

Cost

Delay care due to concern about co-pay

No mid-level medical access (example: urgent care, clinics, etc.)

Urgent care or Saturday/evening primary care

Need to recruit more providers

Poor reimbursement for prevention

Time – putting it aside before it becomes urgent

Need more primary doctors

No urgent care = go to ER

Need more providers to allow for openings in primary care

Good doctors leave town

No back-up for doctors – always on call

Lack of pediatric doctors causing off-island referrals who in turn are not familiar with our resources



Amount of care givers

High Control and High Significance

1 Need outreach to caregivers about resources/assistance/support groups/mental health

2 Central location of information for county-wide resources

3 Need single source of healthcare access info for providers, patients, and agencies

4 We do not have a centralized referral data base – though information may be obtained through insurance company

5 Knowledge of resources available

6 Health literacy

7 No primary care provider so go to ER when it gets bad

8 Uninsured are gaining access through 911 and ER – don’t know where to go

9 Go to specialists vs. primary care

10 Collaboration between community agencies

11 Lack culture for primary care

12 Don’t know who takes their insurance

Step 5: Mapping of High Significance/High Control Root Cause Relationships

Primary Root Cause: Lack of knowledge/awareness about availability and appropriate usage of primary care vs ER/specialty care for all ages

Step 6: Proposed Action Steps and Identification of Individuals/Organizations for Future

Involvement

Action Steps

Coordinate care for patients after they leave ER

Educate doctors and hospital to do better after hospital management

Collaboration between ICPH, UW, WhidbeyHealth, NAS Whidbey, Health Navigators – Resource list: plan to keep it updated, outreach to community regarding importance of insurance, medical provider, when to call 911, SAIL, end of life care, mental health, video clips at offices, library, ER, etc. Posting in Whidbey Times, Mailing outreach, posters

School education about health care system

High school curriculum about programs, Medicare/Medicaid, etc. *Requirements for health education

Info boards, video in waiting rooms with resources in primary languages

1

2 3

4

5 6

7 8

9

10

11

12



Phone book

Multi-pronged outreach – social media, print, visual signs, Channel 10, website

Single resource website maintained by single agency

Distribute info on how to access patient resources

Include and distribute to all organizations: Help House, Elder Care, Senior Center, TLC, other agencies, etc.

Info available at agencies support population that needs services

Info on “What’s an Emergency?”

PSAs

TV announcements regarding what an emergency vs routine medical care

Individuals/Organizations Proposed for Future Involvement

WGH

NHOH

Senior Services

Opportunity Council

United Way

Snohomish County

WGH Hospital Administration

Primary care providers

Health Navigators for Insurance – Opportunity Council


Strengths

Approximately one-third DO report symptoms

Measurable data about the issue

We have 3 publically funded agencies

Early childhood youth and school-based programs are the #3 reported important prevention program

Island County ranked mental health care as a #1 priority for Island County

We have school-based mental health counselors

In 2008 there was a reduction by 6th graders contemplation of suicide

Rate of suicide decreased in 2014 in Island County

Concerns

Gender – Females are higher in Island and state

People don’t know how to access care

Opportunity Council Report – 55% said was cost was a barrier to mental health care

Limited providers with prescribing medication is a barrier to delivering care

Medicare providers not available

Focus Group Theme 1 – Limited availability of mental health providers

II. Depression and Suicide



Rate of hospitalization high - double that of Washington State for 0-14 years of age

Higher rate of suicide contemplation does not seem to be getting better even though hospitalization is higher

Variability noted in rate of hospitalization of children for mental health in Island County, vs stable for Washington State

Variability of rates of suicide – general and the rate of youth hospitalized for mental illness

Serious contemplation of suicide increasing for both 6th and 10th graders

Higher rate of suicide contemplation by 10th graders than state or US

3.5% above Washington State in 6th grade contemplation of suicide

Rate of contemplation increases from 6th to 10th grade

10th grade Island County higher suicide contemplation by 2.3% than Washington

Other

No information on mothers/fathers of 0-14 year olds with depression

Is access to mental health care an issue? What are the # of providers?

Need to know the relationship between military and the high suicide rate. Need more demographic data

What is influencing the up and down swings of hospitalization of 0-14 year olds?

No data on mental health/suicide specific to elders or veterans

No information on adult depression history

What influences rates of suicide?



Primary Issue: Current efforts are not positively affecting the rate of suicide contemplation in youth. Steps 3 and 4: Root Causes and Control/Significance Analysis


None noted.


Rural community with fewer providers

Patients' lack of enthusiasm to see assigned provider

Patients' lack of commitment to receive care

Patients' fear of losing financial state benefits is no longer mentally ill


Bullying: both in person and on social media

Peer pressure

Use of social media: both the parents' use and the youths' use

Hormones and puberty

Self-esteem and self-worth issues

Neglect and abuse from nuclear family



Permissive or progressive boundaries

Lack of positive role models for socially acceptable behavior

Lack of moral/church social structure (values)

Living with grandparents, aunts, uncles, and legal guardians

Death of one or both parents

Military: moving frequently, death or disability of parents, deployment, etc.

Lack of reimbursement from Medicare and Medicaid to providers

Limits on health insurance for number of visits Stigma of mental health issues

Cost of treatment both with and without health insurance

Lack of community involvement (perception that it is not our, community members, responsibility)

Cost to health care agencies to provide services

Cost to healthcare agencies to implement evidence based practice improvements


1 Cost of mental health services

2 Cost of mental health treatment services paid by consumers

3 Access to treatment including distance and transportation issues

4 No single entry point for patients to access mental health services

5 Community lack of awareness of hotlines or who to notify in emergencies

6 Lack of medical home or primary provider

7 Providers lack knowledge or expertise in mental health issues

8 Providers lack knowledge or expertise with prescribing medications for mental health issues

9 Interoperability of medical records

10 Pre-existing conditions (Pervasive Developmental Delays, Mental Retardation, etc.) confounding diagnosis and treatment

11 (Community) Lack of knowledge of signs and symptoms of depression/ suicidal

12 Work schedules of parents to bring youth to appointments

13 Youth missing school to attend appointments


Primary Root Cause: Lack of mental health counseling resources and the cost of mental health



Step 6: Proposed Action Steps and Identification of Individuals/Organizations for Future

Involvement

Action Steps

Hiring or providing more mental health in school

Youth prevention hotline

Single agency point of contact or Primary care home

Whidbey General Hospital acute care tele-health

Forefront Education Coalitions

Interoperability

Future Involvement Military officers – NASWI chaplains provide SafeTalk and Assist Suicide Prevention training regularly and invite community representatives

Sea Mar

Veterans Services

State HIE for interoperability

Seattle Children’s Hospital

The Everett Clinic Mental Health

Providence Everett Hospital

School District administration

City leaders – Mayors, Clinton Community Council, Freeland Council

State legislature representatives for funding

Senior services

Charlene Ray – Island County Human Services

Compass Health


Strengths *

Violent crime rates are low in Island County compared to Washington State

Domestic violence services are “extremely important”

Island County perceived as a safe place to raise kids

For almost a decade, student bullying was under the state average

Quality of a healthy community higher on list #7

Concerns

Domestic violence victims state services are “hard to get”

10th grade students physically hurt above state average

Higher rate of domestic violence compared to state

8th grade bullying is on the rise in Island County

III. Interpersonal Abuse



Crime and violence prevention ranked #3 by 28% of Camano residents

Domestic violence is ranked as #24 out of 25 health concerns

Domestic violence and students reporting being hurt on purpose by an adult is higher than state percentages

24% of respondents indicated DV services as “hard to get”

Island County is higher than Washington in most graphs

2008 and up there is an upward trend among 12th grade students [reporting they were made to feel unsafe by someone they were dating]

Shocking: 31.9% of 10th graders reported physically hurt by an adult

Other

Any correlation between 10th grade students hurt by an adult vs youth living doubled up from the NAEYHE data?

Lack of data related to this topic, especially seniors

Elder abuse and domestic violence among older adults not reflected in data

Elder abuse and financial exploitation

How is bullying defined?

Personal safety vs. domestic abuse?

What are considered “domestic violence victim services?” in the survey

Is the 2008 and after increase because of reporting or actual crime?



Primary Issue: Youth violence and abuse reported higher in Island County than Washington State and trending upwards.

Steps 3 and 4: Root Causes and Control/Significance Analysis


Social pressure

Peer pressure

Social norms that retribution is okay

Economic stress


None reported


Lack of school-based resources

Intervention resources

Lack of things for youth activity

Poor role modeling

Fear of repercussions for reporting

Fear of consequences of reporting

Being around unsafe people



Unstable home environments

Entitlement vs. low self-esteem

Media influence de-sensitized

Self-confidence of youth

Alcohol and substance abuse

De-sensitization/acceptance of violence

Lack of family support to school


1 Awareness of resources available

2 More is reported due to recognition of programs

3 Parenting skills

4 Student training about responsible use of social media

5 Lack of youth empathy

6 Parents intimidated by social media control

7 Social responsibility to appropriate use of social media

8 Youth education about responsible reporting of abuse

9 Lack of conversation between child and parent about violence

10 Unsupervised access to social media

11 Lack of parent training in citizen awareness


Primary Root Cause: Lack of parenting training and resources

Step 6: Proposed Action Steps and Identification of Individuals/Organizations for Future Involvement

Action Steps

Parent training to teach their children about healthy relationships (Social media, alcohol/drug use, bullying)

Coordinated entry program – Island County

211

Collaborate with school districts to parent/student orientation

1

2

3

4

5

6 7 8

9

10

11



Identify different ways to get parents trained

Workgroup/committee to identify and implement actions

Identify access points to provide information

Support groups

Recognize cultural diversity

Future Involvement

NASWI Fleet and Family Services – Tim Schwitalski, Pam Delaney, Kathleen Schofield

All school districts (Coupeville, South Whidbey, Camano Island, Oak Harbor)

CPS

Healthcare Authority

School PTA leaders

Faith Community, including military chaplains


Strengths *

We have good range of resources according to the ALICE report

Island County households spent less of their income on housing in 2011-2013 than in 2008-2010

Spending on housing is equitable across the county, state and nation

Household spending percentage is comparable to state and nation

More Island County youth are doubled up with a parent than on their own

Concerns

Chronic homelessness numbers are increasing

From the Focus Group data, emergency shelter and supportive housing are needed

Blurring of shelter and affordable and available housing

Low income households indicate affordable housing a high concern

Affordable housing is a #1 and #2 ranked issue for low income households in the Island County survey

Affordable housing units are half of the state and national average

Island County has fewer affordable and available units than the state and national averages

Lack of affordable housing units

Scarce housing options that are affordable and available

Less affordable housing in Island County than in Washington or the US

Household annual survival budget is $56,088 and requires an income of $28.04 per hour.

Household survival budget for a family of 4 requires an income equal to the median household income identified by the Census/ACS.

IV. Housing



Household survival budget for a family of 4 requires more income than twice the budget for a single adult.

Homeless numbers are increasing

The number of homeless unsheltered increased significantly

Point in Time counts are increasing in all categories

Homelessness increased by more than a third between 2015 and 2016

Other

Lack of community support and leadership for addressing homelessness and affordable housing

ALICE report is based on 2013 data



Primary Issue: Lack of affordable housing availability is driving up the homeless population Steps 3 and 4: Root Causes and Control/Significance Analysis


Part-time residents


Utilization of houses for full-time use


No federal funding for decades

Regular real estate market does not create affordable housing – needs subsidies

Getting funding for affordable housing is complex with application calendars and the need for experienced developers

High cost of living

Cost of regulation

Cost of building materials

Influx of Navy and population growth

Lack of infrastructure – limited land, water, septic, and regulations

Lack of jobs/employment


1 County staff and leadership interface with local city and town leadership to collaborate on solutions

2 Zoning – Comprehensive plans

3 How to define affordability

4 Public/Political will

5 Lack of prioritization by leaders

6 Gaps in housing continuum

7 A call to action for advocacy to elected officials and broad community leaders to prioritize this issue




Primary Root Cause: Low awareness and public/political will regarding the lack of affordable housing driving up the homeless population.

Step 6: Proposed Action Steps and Identification of Individuals/Organizations for Future Involvement

Action Steps

Public campaign: “Got Housing?”

Identify housing inventory

Clarify infrastructure limits

Define affordability – explain how it pencils out

Clarify what elements are in the Housing Continuum

Share human stories – what is the message?

Identify stakeholders to lead

Future Involvement

Senior Services of Island County

City/Town Planners

Medical professionals serving Camano

Stanwood/Camano schools

Faith community

Chamber leaders

Service groups

1

2

4

5

6

7

3



Discussion In the mid-20th century, social psychologists began to create models of individual behavior to better understand the widespread unacceptance of disease-prevention activities throughout the population. (Riekert et al 2014; p11). Models developed over the next several decades – known collectively as individual behavior change models – emphasize promoting changes in individual cognition and behavior to improve health. However, as decades have research have revealed, this individual-focused approach to behavior change has limited impact. “To date, we have seen that rigorously designed and theoretically informed behavior change interventions often provide only modest changes in health behavior that have not consistently translated into lasting behavior change or had a population-level impact” (Riekert et al 2014;p 29). In response to decades of disappointing individual behavior-focused interventions, a new collection of models known as “socio-ecological models” (SEM) have been developed by researchers that account for how people interact with their physical, social, and cultural environments – and how these external factors influence individual behavior. Research continues to reveal the power of these multi-level factors, and the public health system has taken great strides in the past decade to invest in multi-SEM level interventions. Figure 1. Centers for Disease Control and Prevention (CDC) Diagram of a Socio-Ecological Model.

Source: Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion. Available at: http://www.cdc.gov/obesity/health_equity/culturalRelevance.html

A Socio-Ecological Model (SEM) does not disregard the role of individual knowledge and attitudes, but places them within a much larger context of influential factors that include social networks, organizations, collaboration between organizations, and policies that impact the physical environment. Interventions that aim to generate widespread, lasting population health change must address all levels. Interventions that only target one or two levels must be realistic about their ability to generate behavior change, and set goals that are reasonable for the limited reach and investment.

http://www.cdc.gov/chronicdisease



As workshop participants went through the series of exercises, they were asked to brainstorm root causes for their primary concern, evaluate each root cause on the group’s perceived level of control to impact that root cause, and evaluate the level of significance it would have on the primary concern. Participants were then asked to select one root cause they thought would be the most impactful and to brainstorm action steps on how best to generate positive change. Categorizing these primary concerns and root causes by their location on the SEM provides a valuable perspective on participants’ behavior change ideology, and on which SEM levels there was perceived control. Access to Care The selected primary concern of ‘Appropriate use of primary care versus emergency room care’ is an individual-level outcome within the SEM. The majority of root causes evaluated by the workgroup as “highly significant” but with “low control” (HSLC) were those causes originating at the “Institution and Organization” level of the Socio-Ecological Model (66%). Root causes evaluated as “highly significant” with “high control” (HSHC) were at the “Community” level (42%) and “Individual” level (50%). Two root cause selected as most impactful were ‘Lack of knowledge/awareness about available resources” and “Lack of knowledge/awareness on appropriate use of primary care versus emergency room care’. Both root causes are within the ‘Individual’ level of the SEM. Depression and Suicide ‘Serious suicide contemplation’ was selected as the primary concern for this focus area, and is an individual-level outcome within the SEM. The greatest number of HSLC root causes were within the “Interpersonal” level (44%), followed by the “Institution and Organization” level (33%). HSHC root causes evaluated were at the “Institutional and Organization” level (39%), “Individual” level (30%), and “Community” level (23%). Two root causes were identified as most impactful: ‘Lack of mental health resources’ and ‘Cost of mental health services’, both located within the ‘Institution and Organization’ level of the SEM. Interpersonal Abuse The selected primary concern of ‘Violence directed toward youth or between youth’ in an interpersonal level outcome within the SEM. HSLC root causes were primarily at the Individual level (43%) and Interpersonal level (29%). HSHC causes were also at the Individual level (55%), and the Interpersonal level (27%). The most impactful HSHC root cause selected by the workgroup was ‘Lack of parenting training and resources’ which could placed in either the “individual” or “interpersonal” levels. Housing ‘Lack of affordable housing availability is driving up the homeless population’, was the only primary concern at the structures and system levels of the SEM. HSLC root causes were primarily at the Structures and Systems level (56%) and Institution and Organization level (33%). HSHC root causes were evenly dispersed between Structures and Systems (29%), Community (29%), and Institutional and Organization (29%). One root cause was at the Individual level. The most impactful HSHC root cause selected by the workgroup was the one Individual level cause, described as “Public will”.



Conclusions A lack of individual knowledge is at the foundation of all four workgroup’s most impactful HSHC root causes. Two groups framed their root cause on the lack of community resources (Institution and Organization level), but the intent of increasing availability of those resources is for education of individuals on the desired behavior. As we have learned from research on individual behavior and socio-ecological models, improving population health does require individual knowledge and attitude change, but cannot stop there. There must be interventions within the interpersonal, institutional and organization, community, and systems and structures levels. The next step in development of the Island County Community Health Improvement Plan (CHIP) is to establish four workgroups, one for each of the primary issues identified. Each workgroup will be tasked with completing additional evaluation of sub-population data, researching evidence-based solutions, and selecting the most appropriate and feasible interventions. The work completed at Workshop #2 will provide the foundation for that work, and as we have seen, provide valuable recommendations for impacting individual knowledge and attitudes. Future work should also include the evaluation of interpersonal, institutional and organizational, community, and systems level interventions to create a comprehensive approach towards population health improvement.



Appendix A. Workshop Data Posters



Appendix B. Workshop Agenda

Community Health Prioritization Workshop – Round #2 Root Causes, Mapping, and Action Steps Date: Wednesday, April 13, 2016 Coupeville Recreation Hall, 901 NW Alexander St, Coupeville, WA 98239 10:30-2:30pm

Workshop Agenda Doors open at 10:15am – Please come early to sign-in, find your group, and get coffee or tea. Welcome & Introduction Keith Higman, Director, Island County Public Health

Island County Community Health Planning Summary Laura Luginbill, Assessment and Healthy Communities Director, Island County Public Health

Data Carousel Bess Windecker Nelson, PhD, Family Touchstone, LLC Lunch Break Lunch will be provided. This will be a “working lunch”. A brief break will be provided, and then group work will resume.

Data Carousel Response Bess Windecker Nelson, PhD, Family Touchstone, LLC

Root Cause Analysis

Significance/Control Evaluation

Relationship Mapping Next Steps Brainstorm

Wrap-Up and Concluding Comments Laura Luginbill, Assessment and Healthy Communities Director, Island County Public Health

END TIME: 2:30 PM

START TIME: 10:30 AM



Appendix C. Workshop Participants

Name Organization Title Group

Anania, Teri Island County Housing Authority Executive Director Housing

Ballay, Catherine CHAB Chair Staff

Burgoyne, Annalee Sea Mar Community Health Centers Dental Supervisor - Oak Harbor Access to Care

Callison, Tim City of Langley Mayor Depression and Suicide

Clark, Lisa Opportunity Council Executive Director Housing

Crager, Deb Whidbey General Hospital Paramedic Access to Care

Denman, Rene Toddler Learning Center Executive Director Interpersonal Abuse

Grason, Holly Johns Hopkins Bloomberg School of Public Health

Associate Professor Interpersonal Abuse

Hanken, Jamie Sunrise Services Clinical Director Depression and Suicide

Henderson, Jackie Island County Human Services Director Depression and Suicide

Higman, Keith Island County Public Health Director Staff

Jacks, Karla Camano Center Executive Director Housing

Judd, Caitlin CADA Community Educator Interpersonal Abuse

King, Steve Oak Harbor School District Assistant Superintendent Depression and Suicide

Kovach, Brenda Fleet and Family Support Services School Liaison Officer Interpersonal Abuse

Lavassar, Gail Readiness to Learn Executive Director Housing

Luginbill, Laura Island County Public Health Assessment & Healthy Communities Director Staff

Macys, Dave Island County CHAB Member Housing

Maughan, Emily Island County Public Health Public Health Coordinator Staff

May, Robert

Whidbey General Hospital Lead Paramedic Access to Care

Mendlik, Lorrie Sunrise Services Island County Interpersonal Abuse



Pelant, Joanne Island County Human Services Housing Program Coordinator Housing

Price, Laura Island County Law Enforcement Sergeant Interpersonal Abuse

Richards, Lynda Island County Human Services Assistant Director Housing

Robinson, Cynde CADA Executive Director Interpersonal Abuse

Robinson-Fritz, June Social and Health Services (DSHS) Administrator - Oak Harbor CSO Interpersonal Abuse

Rogers Decker, Vivian Oak Harbor School District Homeless Liaison Housing

Saunders, Heidi Whidbey General Hospital Director of Care Transitions Depression and Suicide

Servatius, Celine Naval Hospital Oak Harbor Preventive Medicine Access to Care

Smith, Charlie Central Whidbey Fire and Rescue Chief Deputy Access to Care

Strong, Jo Swedish Medical Center Pediatric Nurse Depression and Suicide

Thomas, Brad Island County Public Health Health Officer Access to Care

Tormey, Kellie Oak Harbor School District Communications Director Interpersonal Abuse

VanWetter, Catherine Forefront - University of Washington Suicide Prevention Coordinator Depression and Suicide

Vives, Desiree Sea Mar Community Health Centers Northern Dental Regional Manager Access to Care

Wilder, Faith South Whidbey Homeless Coalition Executive Director Housing

Wood, Jill Island County Public Health Environmental Health Director Housing

Yorioka, Gerald Washington Academy of Family Physicians Former President Access to Care

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